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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006190
Report Date: 05/09/2024
Date Signed: 05/09/2024 12:05:07 PM

Document Has Been Signed on 05/09/2024 12:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:4CS WINDSOR STATE PRESCHOOLFACILITY NUMBER:
493006190
ADMINISTRATOR/
DIRECTOR:		MICHELLE MARTINFACILITY TYPE:
850
ADDRESS:79 PLEASANT AVENUETELEPHONE:
(707) 836-7068
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 23DATE:
05/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Michelle MartinTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Glenn Ouye arrived to continue investigating a self reported incident where a parent reported to the Site Supervisor that a child C1 was handled in a rough manner, specifically that a child was grabbed and thrown into a calm area of the classroom.

LPA interviewed staff and a number of children. LPA also interviewed the reporting party. The interview with staff and children provided consistent statements which do not support a finding that any children were handled in a rough manner. Therefore there is not a preponderance of evidence to support that a child being handled in a rough manner took place.

No deficiency issued as a result of the site visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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